Extrapulmonary manifestations of COVID-19: Radiologic and clinical overview

Abstract

COVID-19 is principally a respiratory illness and pulmonary manifestations constitute main presentations of the disease. According to the reported studies, SARS-CoV-2 infection is not limited to the respiratory system and other organs can be also affected. Renal dysfunction, gastrointestinal complications, liver dysfunction, cardiac manifestations, mediastinal findings, neurological abnormalities, and hematological manifestations are among the reported extrapulmonary features. Considering the broad spectrum of clinical manifestations and the increasing worldwide burden of the disease, there is an urgent need to rapidly scale up the diagnostic capacity to detect COVID-19 and its complications. This paper focuses on the most common extrapulmonary manifestations in patients with COVID-19 pneumonia. Further studies are needed to elaborate and confirm the causative relationship between SARS-CoV-2 and the reported extrapulmonary manifestations of COVID-19.

Keywords: COVID-19; Extrapulmonary manifestation; Gastrointestinal complications; Liver dysfunction; Lymphadenopathy; Neurological manifestations; Pericardial effusion; Renal dysfunction; SARS-CoV-2.

Fig. 1

A 31-year-old male was admitted for few days of abdominal discomfort and absent bowel movement. On his abdominopelvic CT, mild to moderate nonspecific stranding surrounding mildly distended fluid-filled ascending colon (A, B) without evidence of bowel obstruction was identified. Few small pericecal lymph nodes were also identified (C). Incidentally, patchy ground glass opacities with reverse halo appearance were found involving bilateral lung bases (D), concerning for COVID 19. Follow up dedicate chest CT scan and RT-PCR confirmed infection with SARS-CoV-2.

Fig. 2

A 60-year-old female presented with 4 days of dry cough without fever or dyspnea. She denied any past medical history of cardiac disease or pulmonary disease. Chest CT demonstrated multifocal peripheral patchy ground glass opacities with small superimposed consolidations (boxes, A and B). Small pericardial effusion (white arrows) was also noted. Patient RT-PCR for SARS-CoV-2 was subsequently reported as positive.

Fig. 3

Chest CT of a 20-year-old female presented with fever, dyspnea, and tachypnea for 3 days without known underlying disease or previous cardiac or respiratory condition. Small bilateral pleural effusion (right greater than left) is identified (a–d). Mild cardiomegaly/left ventriculomegaly (b) and pericardial effusion (thick arrows, a and b) are noted. Bilateral ground-glass opacities (right greater than left) with superimposed nodular consolidations (boxes) are identified. COVID-19 RT-PCR was positive for SARS-CoV-2.

Fig. 4

Chest CT scan of a 59-year-old male with RT-PCR positive for COVID-19 who presented with dyspnea, tachypnea, myalgia and low grade fever for 5 days. Enlarged bilateral lower paratracheal and aortopulmonary window lymph nodes (white arrows, a and b) are identified. Bilateral patchy ground glass opacities and consolidations in a peripheral predominant pattern (boxes, c and d) are noted with bilateral lungs.